Urogenital Tract Infection

UPOINT System: A Diagnostic/Therapeutic Algorithm for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Phil Hyun Song; Urogenit Tract Infect 2020;15(2):27-32. Published online August 31, 2020; DOI: https://doi.org/10.14777/uti.2020.15.2.27

Abstract PDF PubReader ePub: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition that significantly affects the quality of life. On the other hand, urologists find it challenging to treat this disorder effectively. To date, the Urinary, Psychosocial, Organ-Specific, Infection, Neurological/Systemic, and Tenderness (UPOINT) system is the only classification tool that can improve the treatment outcomes significantly compared to monotherapy. This review focused on the most recent advances in the diagnosis and treatment of CP/CPPS.

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Risk Factors of Febrile Urinary Tract Infection after Ureteral Reimplantation in Infant: Seungsoo Lee, Jae Min Chung, Sang Don Lee; Urogenit Tract Infect 2020;15(2):33-37. Published online August 31, 2020; DOI: https://doi.org/10.14777/uti.2020.15.2.33

Abstract PDF PubReader ePub: Purpose: Children with febrile urinary tract infection (fUTI) and vesicoureteral reflux (VUR) show significant morbidity. Few studies have examined the incidence of fUTI after ureteral reimplantation for congenital urinary tract anomalies, particularly in infants. Therefore, this study examined the incidence and risk factors of fUTI after ureteral reimplantation in infants.
Materials and Methods: Children under one year of age, who underwent ureteral reimplantation from July 2017 to December 2018, were reviewed retrospectively. The patients’ data were analyzed to evaluate the predictors of fUTI after ureteral reimplantation.
Results: Ureteral reimplantation was performed in 16 patients (25 ureters) at a mean of 8.9±2.8 months. The preoperative diagnosis was VUR 14 (87.5%), obstructive megaureter 1 (6.3%), duplicated ureter 1 (6.3%). Postoperative fUTI occurred in five patients (31.3%) during the follow-up period (average 9.6±5.9 months, range 3-18 months). UTI occurred at 40.8±16.6 (17-61) days after surgery. Fourteen ureters were implanted with a ureteral catheter for three days, and 11 ureters were implanted with a double J ureteral stent for six weeks. The children’s age, sex, surgical method, renal scar, reflux grade, laterality, persisting VUR, and presence of double J ureteral stent were not predictive factors for postoperative fUTI.
Conclusions: The incidence of fUTI after ureteral reimplantation in infants was 31.3%, and all fUTI occurred within two months after surgery. The risk factors associated with fUTI after ureteral reimplantation could not be predicted.

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Performance of the Sysmex UF-1000i System in Screening for Significant Bacteriuria in Patients with Bladder Cancer Who Received Bacillus Calmette-Guérin Treatment: Tae Hee Kim, Seung Il Jung, Myung Soo Kim, Hyun-Jung Choi, Ho Seok Chung, Eu Chang Hwang, Dong Deuk Kwon; Urogenit Tract Infect 2020;15(2):38-46. Published online August 31, 2020; DOI: https://doi.org/10.14777/uti.2020.15.2.38

Abstract PDF PubReader ePub: Purpose: Diagnosing urinary tract infections by urine culture is time-consuming during a Bacillus Calmette-Guérin treatment. Because the urine culture results take time to collect, patients are treated presumptively, or Bacillus Calmette-Guérin is discontinued before the results. This study evaluated the ability of the Sysmex UF-1000i system to examine the urine bacterial count and determine if it could be used to predict a positive culture.
Materials and Methods: 180 patients who underwent transurethral resection for bladder tumors and received intravesical Bacillus Calmette-Guérin treatment between January 2017 and July 2018 were evaluated prospectively. For patients who received an intravesical Bacillus Calmette-Guérin treatment, urine flow cytometry, and urine cultures were assessed weekly during the treatment period.
Results: During Bacillus Calmette-Guérin instillation, 44, 146, and 27 patients had bacteriuria, pyuria, and positive urine nitrite, respectively. Multivariate analysis indicated that the predictors associated with bacteriuria included the urine flow cytometry results of ＞100 bacteria/µl (odds ratio, 22.73; p＜0.001) and positive urine nitrite (odds ratio, 5.67; p=0.012) at the time of sampling for positive urine culture. The area under the receiver operative characteristic curve for diagnosing bacteriuria by urine flow cytometry was 0.825. A urine flow cytometry cutoff value of ＞100 bacteria/µl resulted in a sensitivity and specificity of 75% and 90.91%, respectively. Using the cutoff of ＞1,000 bacteria/µl, the sensitivity and specificity were 50% and 94.85%, respectively.
Conclusions: Rapid urinary tract infection diagnosis using Sysmex UF-1000i can be used to determine whether to treat an infection and to avoid unnecessary Bacillus Calmette-Guérin discontinuation and urine culture tests.

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Rates and Risk Factors of Bacteriuria in Patients with Bladder Cancer Who Underwent Treatment with Bacillus Calmette-Guérin: Seong Jong Eun, Myung Soo Kim, Seung Il Jung, Hyun-Jung Choi, Ho Seok Chung, Eu Chang Hwang, Dong Deuk Kwon; Urogenit Tract Infect 2020;15(2):47-53. Published online August 31, 2020; DOI: https://doi.org/10.14777/uti.2020.15.2.47

Abstract PDF PubReader ePub: Purpose: This study evaluated the rate and predictors of bacteriuria in patients who underwent transurethral resection of bladder tumor (TURBT) and Bacillus Calmette-Guérin (BCG) treatment.
Materials and Methods: We prospectively evaluated 266 patients who underwent TURBT and intravesical BCG treatment between January 2017 and September 2019. Urinalysis and urine culture were performed at the baseline, one to two weeks after TURBT and weekly during the BCG treatment period. The primary outcomes were the bacteriuria rates in BCG-treated patients, while the secondary outcomes were the risk factors of bacteriuria during BCG treatments.
Results: Of the 266 patients, the rate of bacteriuria was 4.5% before TURBT, 5.3% in the postoperative period, and 24.4% in the BCG treatment period. After BCG instillation, urinalysis showed that 204 and 38 patients tested positive for pyuria and nitrite, respectively. Multivariate analysis indicated that the risk factors associated with bacteriuria during BCG treatment included age (odds ratio [OR]: 1.06; p=0.003), sex (female) (OR, 5.41; p=0.007), diabetes mellitus (DM) (OR, 2.82; p=0.023), postoperative bacteriuria (OR, 8.08; p=0.032), bacterial counts>100/µl in urine flow cytometry (OR, 29.72; p<0.001), and positive urine nitrite test (OR, 6.20; p=0.001) at the time of positive urine culture sampling.
Conclusions: Approximately 25% of the patients suffered from bacteriuria during intravesical BCG treatment. Old age, female sex, DM, and postoperative bacteriuria were found to be the risk factors of bacteriuria during BCG treatment. Predictive factors could aid in clinical decisions during BCG treatments as well as decisions on BCG discontinuation.

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Seminal Vesicle Infection of Zinner Syndrome Misdiagnosed for Neoplasm: Young Joo Kim; Urogenit Tract Infect 2020;15(2):54-56. Published online August 31, 2020; DOI: https://doi.org/10.14777/uti.2020.15.2.54

Abstract PDF PubReader ePub: Zinner syndrome is a rare Müllerian duct congenital anomaly representing unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction. A 16-year-patient presented with dysuria, nocturia, and enduring diffuse perineal pain for two months. Radiologic studies revealed a right seminal vesicle cyst with a mass lesion and right renal agenesis. Ultrasonography guided transrectal biopsy indicated a seminal vesicle neoplasm. The mass was diagnosed as chronic inflammation. This paper reports a case of seminal vesicle inflammation associated with Zinner syndrome that was initially misdiagnosed as a neoplasm.

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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: Incorporating Considerations of Resources Use into Grading Recommendations’ (A Secondary Publication): Hong Wook Kim, Jae Hung Jung, Do Kyung Kim, Ho Won Kang, Ja Yoon Ku, Hyun Jin Jung, Eu Chang Hwang, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation; Urogenit Tract Infect 2020;15(2):57-62. Published online August 31, 2020; DOI: https://doi.org/10.14777/uti.2020.15.2.57

Abstract PDF Supplementary Material PubReader ePub: This article is the fifth translation of a GRADE series published in the BMJ for incorporating the considerations of resources use into grading recommendations. Clinical recommendations inevitably involve judgments about the allocation of resources use (costs). Although costs differ from typical healthcare outcomes, such as mortality, morbidity, and quality of life, costs are another potentially important outcome that differs across and within a jurisdiction. A balance sheet is a useful method for determining if the net benefits are worth the incremental costs. Resource use, not just monetary values, should always be presented in an evidence profile. Formal economic modeling may or may not help judge the certainty of the evidence for resource use.

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